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VOLUNTEER FIREFIGHTERS' RELIEF ASSOCIATION <br />REPORTING FORM <br />ANNUAL CORPORATE REGISTRATION FOR 1995 <br />PENSION INFORMATION FOR THE YEAR ENDED DECEMBER 31, 1994 <br />GENERAL INFORMATION: <br />1. CORPORATE CHAR it NUMBER: <br />D -711 <br />2. CORPORATE NAME: <br />Little Canada Firemen's Relief Association <br />3. REGISTERED ADDRESS: <br />325 Little Canada Road <br />St. Paul, MN 55117 <br />4. REGISTERED AGENT (REQUIRED ONLY (F AN AGENT IS <br />LISTED IN THE ORIGINAL ARTICLES OF INCORPORATION OR <br />SUBSEQUENT AMENDMENTS): <br />None <br />PLEASE READ ALL INFORMATION BELOW: <br />INFORMATION FROM PART 1 OF THIS FORM IS <br />PROVIDED TO THE OFFICE OF THE SECRETARY OF <br />STATE AS/ CORPORATE REGISTRATION <br />INFORMATION. <br />ITEMS 1-4, IF PRE-PRINTED, LIST INFORMATION <br />CURRENTLY ON FILE WITH THE OFFICE OF THE <br />SECRETARY OF STATE. IF ITEMS 2-4 ARE NO <br />LONGER CURRENT, YOU MUST COMPLETE AN <br />AMENDMENT TO THE ARTICLES OF <br />INCORPORATION. YOU MAY OBTAIN AN <br />AMENDMENT FORM BY CALLING (612) 296 -2803. <br />THERE IS A 535.00 FEE FOR FILING AN <br />AMENDMENT. <br />YOU MUST LIST CURRENT INFORMATION FOR <br />ITEMS 5 -7. <br />5. NAME OF CORPORATE PRESIDENT: <br />Joe Vitale <br />6. NAME AND TFI FPHONE NUMBER OF CONTACT PERSON FOR THE CORPORATION: <br />Joe Vitale PHONE: ( ) Home: 484 -4607; work <br />484 -7215 <br />7. MAILING ADDRESS: <br />325 Little Canada Road, St. Paul, MN 55117 <br />FIRE DEPARTMENT INFORMATION: <br />THE FIRE DEPARTMENT YOUR ASSOC. IS AFFILIATED WITH I5 A: <br />MUNICIPAL FIRE DEPARTMENT <br />X INDEPENDENT NON - PROFIT FIREFIGHTING CORPORATION <br />NUMBER OF ACTIVE MEMBERS IN YOUR FIE DEPARTMENT <br />BENEFITS INFORMATION <br />TYPE OF SERVICE PENSION BENEFIT: <br />X LUMP SUM <br />DEFINED CONTRIBUTION (SPLIT THE PIE) <br />-- MONTHLY SERVICE PENSION <br />OTHER (SPECIFY) <br />RELIEF ASSOCIATION INFORMATION: <br />35 No. OF ACTIVE MEMBERS IN THE RELIEF <br />0 NO. OF RETIRED/DISABLED RECEIVING BENEFITS <br />2 NO. OF RETIRED MEMBERS ON DEFERRED PENSIONS <br />37 TOTAL RELIEF MEMBERSHIP <br />OTHER BENEFITS AMOUNT <br />SHORT TERM DISABILITY S same 8s lA1mD S <br />x LONG TERM DISABIITY S <br />DEATH/FUNERAL BENEFIT S c P „G ld n c m <br />SURVIVOR <br />BENEFIT <br />PER <br />Page 87 <br />